|The following article features coverage from the ONA 2019 Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
Background Tobacco use during cancer therapy adversely impacts outcomes and, after treatment, increases risk of disease progression and mortality. The National Comprehensive Cancer Network recommends that all patients with cancer be offered evidence-based treatment for tobacco cessation. However, few cancer centers in the United States routinely offer comprehensive tobacco cessation programming. An effective treatment program for tobacco use, including nicotine replacement therapy (NRT) and behavioral support, can triple a patient’s chances of successfully quitting tobacco. Tobacco use is frequently captured in a patient’s electronic health record (EHR), but oncology clinicians are focused on the treatment of the patient and often miss the opportunity to systematically address tobacco use. The oncology nurse navigator (ONN) team is focused on patient needs and assures successful implementation of the treatment plan, which should include tobacco cessation.
In response to the National Cancer Institute (NCI) Cancer Moonshot Program, the University of Arizona Cancer Center (UACC) has assembled a multidisciplinary group guided by the ONN team to design, implement, and evaluate the Responsive Engagement and Cessation in Cancer Health (REACCH) program, an evidence-based, comprehensive tobacco cessation program. The REACCH program aims to increase tobacco abstinence and improve prognosis after a cancer diagnosis.
Methods New patients at the UACC are contacted by a member of the ONN team and asked about tobacco use and history during the ONN New Patient Barriers to Care and Psychosocial Assessment. If a patient identifies as a tobacco user, the ONN delivers a brief intervention and provides a referral to the REACCH program tobacco treatment specialist (TTS) through the EHR.
The TTS offers evidence-based strategies for quitting and develops an individualized tobacco dependence treatment plan, which may include education material, NRT, and in-person or telephone-based coaching with repeated follow-up. Metrics include program utilization and effectiveness, including assessment of tobacco use for all patients per the NCI definition of a smoker and 7-day point prevalence of tobacco use at 6-month follow-up.
Results Since the launch of the REACCH program on January 1, 2019, 774 new patients have been screened for tobacco use. Of these, 114 patients have identified as tobacco users. The majority of patients report a history of lung or head and neck cancer, have a mean age of 61, and 96% report using cigarettes. 100% of tobacco users have been referred to the REACCH program. Approximately 15% have received NRT, and 61.4% have received at least one tobacco cessation telephone counseling session. The first available date for 6-month program use and effectiveness is July 1, 2019.
Conclusions With ONN team support, we have implemented a comprehensive tobacco cessation program. The next step in REACCH implementation is to provide training in the program to all disease-site teams, including how to place referrals in the EHR. Results to date suggest that an ONN-led program for tobacco cessation can successfully and accurately identify patients who use tobacco and provide a tobacco cessation treatment plan specifically tailored to the needs of oncology patients.